Provider Demographics
NPI:1871899807
Name:CRAWFORD, BENJAMIN DREW (OD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DREW
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112325
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-2325
Mailing Address - Country:US
Mailing Address - Phone:907-346-3880
Mailing Address - Fax:
Practice Address - Street 1:207 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:#101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2731
Practice Address - Country:US
Practice Address - Phone:907-272-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist